Summary: Clinical Clerkship Program

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1 Background
Preparation of medical and nursing students to enter into clinical practice has for a long-time been based on clinical clerkship program; where students are allowed to learn and practice various clinical skills under the supervision of a qualified health practitioner, in their respective clinical fields (Prince et al. 2005; Jalili, Mirzazadeh and Azarpira 2008; Kim & Myung 2014). Real encounters with patients in hospital setting are a critical component for preparing medical students to apply their pre-clinical knowledge and skills in real clinical practice. Importantly, it allows students to develop stable clinical thinking, communication skills, and professional attitude (Kim & Myung 2014). However, data from extensive surveys
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Prince et al. (2005) previously surveyed fourth year medical students on the effect of transition from pre-clinical to clinical practice (during clinical clerkship programs) on their perceived workload, clinical knowledge/skills and learning. It was revealed that the students were uncertain as to how to behave and act, mainly because they were uncertain of what was expected of them. The students also reported a drastic increase in clinical workload, which reduced their study hours. Consequently, a majority of students felt they were moderately prepared with regard to applying their pre-clinical knowledge and skills (ibid).
To enhance learning experience and self-efficacy of medical students who are in transition from pre-clinical to clinical practice, simulation-based medical education (SBME) is increasingly being utilized for teaching clinical skills in undergraduate medical students as prerequisite or an adjunct to the traditional clinical clerkship program; thanks to the increasing use of technology in healthcare and innovative educational methods (Lewis, Strachan & Smith 2012; Sperling, Clark & Kang
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It is rapidly becoming essential for many nurse educators in nursing schools (Weaver 2011), as it overcomes challenges such as a limited number of clinical sites, especially in rural hospitals where certain types of patients or disease conditions are rare or patients have a shorter hospital stay (Piette et al. 2015).There is extensive evidence as summarized in recent systematic reviews, indicating that the HFPS learning concept is useful in nursing and midwifery education (Cooper et al. 2012; Lapkin et al. 2010; O'Leary, Nash, & Lewis 2015). Evidence summarized in these systematic reviews consistently indicates that the use of HFPS by undergraduate student nurses improves their knowledge acquisition, psychomotor skills, and clinical reasoning skills, self-confidence, as well as student satisfaction. However, there is a gap of knowledge regarding the effectiveness of HFPS learning concept in improving self-efficacy while reducing anxiety levels in student nurses. Anxiety in the sittings of learning has been described as a mastery state of fear, worries and apprehension (Santrock et al. 2010). Anxiety is common among undergraduate nursing students being introduced to clinical clerkship program Zargarzadeh & Shirazi (2014). Nursing students considered that the inadequate supervision, lack of supportive relationships, and teacher inaccessibility were contributing to raise

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